不同来源频发室性早搏射频消融前后左房功能变化

发布时间：2018-06-02 10:18

本文选题：室性早搏 + 不同来源　；参考：《河北医科大学》2016年硕士论文

【摘要】：目的:频发室性早搏不仅可影响心室功能,也有可能影响心房功能。射频消融术成功治疗频发室性早搏后大多数患者左室功能可得到改善,左房容积也较前减小。但对于不同来源频发室早对左房结构及功能的影响,及成功消融后4周内不同来源室早左房结构及功能是否有变化、变化趋势是否不同等方面的研究则无明确结论。本试验通过对比不同来源频发室早患者射频消融术前及术后左心房功能指标的变化,了解成功射频术后左心房功能变化及不同起源频发室早对左心房功能的变化是否影响,从而指导临床室性早搏治疗。方法:顺序收集于2014年12月-2015年12月在我院心内一科住院,24小时室早总数10000,且成功行射频消融术治疗的频发室早患者68例.其中右室来源频发室性早搏患者41例(年龄:47±15岁;男性15例),左室来源频发室性早搏患者27例(年龄:50±17岁;男性16例)。所有入选患者在治疗前询问病史,完善术前检查。射频消融手术均由同一术者进行,并均行统一术式即CARTO三维电解剖标测系统引导下采用电激动标测与起搏标测相结合的方法对PVCs起源位置进行精确定位并进行消融。所有入选患者均于术前、术后1天、术后2周、术后1个月采用心脏超声二维斑点追踪技术观察左心房结构和功能指标。结果:1左心房结构指标左心房直径:右室来源组,左房直径呈缓慢减小趋势,于术后2周达最低点,差异有统计学意义(P0.05),术后4周较术后2周略有升高但较术前仍有减小的趋势,且差异均无统计学意义(P0.05);左室来源组:术前、术后1天、术后2周、术后4周间差异无统计学意义(P0.05)。组间比较,术后右室来源组左房直径减小有较左室来源组变化更明显的趋势,但组间差异无统计学意义(P0.05)。2左心房功能指标左心房射血分数:右室来源组术前左心房射血分数较健康人群显著降低(63.6±9.3 vs70.3±9.2%,P0.05);术后左心房射血分数缓慢升高于术后4周达最高点,较术前显著升高(P0.05);左室来源组:术前较健康人群降低(60.9±12.2 vs70.3±9.2%,P0.05);术前、术后1天、术后2周、术后4周间差异无统计学意义(P0.05)。组间比较,右室来源组左心房射血分数升高有较左室来源组变化更明显的趋势,但间差异无统计学意义(P0.05)。3左心房应变指标3.1左心房应变(Strain S):左右室来源组内,术前、术后1天、术后2周、术后4周间差异有统计学意义(P0.05),各时段左心房应变有逐渐增高的趋势;组间比较,术前右室来源组及左室来源组间差异无统计学意义(P0.05),术后右室来源组各时间段左心房应变高于左室来源组(P0.05)。3.2左心房应变率(Strain rate SR)3.2.1左心室收缩期(Left ventricular systolic SRs):右室来源组,术前、术后1天、术后2周、术后4周间差异有统计学意义(P0.05),各时段SRs有缓慢增高趋势,于术后4周达到最高值;左室来源组内比较,术后1天较术前显著减小(P0.05),后逐渐升高,术后2周较术前仍有减小趋势,但差异无统计学意义(P0.05),术后4周较术前有升高趋势,差异无统计学意义(P0.05);组间比较,右室来源组术后SRs升高有优于左室来源组的趋势,但组间差异无统计学意义(P0.05)。3.2.2左心室舒张早期(Left ventricular diastolic early SRe):组内比较,术前、术后1天、术后2周、术后4周间差异无统计学意义(P0.05);组间比较,术前右室来源组及左室来源组间差异无统计学意义(P0.05),术后右室来源组各时间段SRe优于左室来源组(P0.05)。3.2.3左心房收缩期(Left atrial systolic SRa):右室来源组,术后1天较术前略小,差异无统计学意义(P0.05);后逐渐升高,术后2周、术后4周均较术前显著升高(P0.05),术后2周与术后4周间差异无统计学意义(P0.05);左室来源组,术前、术后1天、术后2周、术后4周间差异均无统计学意义(P0.05);组间比较,右室来源组术后SRa升高呈优于左室来源组的趋势,但组间差异无统计学意义(P0.05)。结论:1右室来源频发室早射频消融术后2周左房直径较术前显著减小。2左室来源组频发室早射频消融术后4周内左房直径无明显变化。3右室来源组频发室早射频消融术前左房射血功能下降,消融术后4周后左房射血功能显著改善,左心房应变、应变率术后1天至4周内缓慢升高。4左室来源频发室早频消融术前左房射血功能下降,射频消融术后4周内左房射血功能无明显改善,左心房应变于术后1天至4周内缓慢升高。5射频消融术后,右室来源组左房功能恢复较显著。
[Abstract]:Objective: frequent ventricular premature beats can not only affect ventricular function, but also affect atrial function. Radiofrequency ablation can improve left ventricular function in most patients after frequent ventricular premature beats, and the volume of left atrium is smaller than before. However, the effect of different sources on left atrial structure and function in different sources and 4 weeks after successful ablation is not. There is no definite conclusion in the study of whether the structure and function of early left atrium are changed in the same source room, and the change trend is different. This experiment is to compare the changes of the left atrium function before and after the radiofrequency ablation in different sources of frequent ventricular early patients. Whether or not the changes in left atrium function can guide the treatment of ventricular premature beat. Methods: the sequence was collected in a hospital in the heart of our hospital in December -2015 December 2014, the total number of 24 hours room early 10000, and 68 cases of frequent ventricular premature patients who were successfully treated with radiofrequency ablation. 41 cases of right ventricular premature ventricular premature beat (age: 47 + 15 years old) 15 male cases), 27 cases of frequent ventricular premature beat of left ventricular origin (age: 50 + 17 years old; male 16 cases). All the selected patients asked the medical history before the treatment and perfected the preoperative examination. All the radiofrequency ablation operations were all performed by the same operator, and all the patients were guided by the CARTO three-dimensional electric dissection system under the guidance of electric excitation and pacing. The location of PVCs origin was accurately located and ablation. All the patients were selected before operation, 1 days after operation, 2 weeks after operation, and 1 months after the operation, the left atrium structure and function index were observed by echocardiography two dimensional speckle tracking technique. Results: 1 left atrium structure index left atrial diameter: right ventricular source group, left atrial diameter slowly decreasing The trend, 2 weeks after the operation reached the lowest point, the difference was statistically significant (P0.05), 4 weeks after the operation was slightly higher than the 2 weeks after the operation, but the difference was still less than before the operation, and the difference was not statistically significant (P0.05); the left ventricular source group: preoperative, 1 days after operation, 2 weeks after operation, there was no statistical difference between the 4 weeks after the operation (P0.05). Group comparison, right ventricular source group left after operation left The decrease of room diameter was more obvious than that of the left ventricular source group, but there was no significant difference between the groups (P0.05).2 left atrium function index left atrial ejection fraction: the left atrial ejection fraction of the right ventricular source group was significantly lower than that of the healthy group (63.6 + 9.3 vs70.3 + 9.2%, P0.05) before operation, and the left atrium blood fraction of left atrium was slowly higher than that of the postoperative 4 weeks after operation. The highest point was significantly higher than that before operation (P0.05); the left ventricular source group was lower than the healthy population (60.9 + 12.2 vs70.3 + 9.2%, P0.05) before operation; before operation, 1 days after operation, 2 weeks after operation, there was no significant difference between 4 weeks after operation (P0.05). The difference was not statistically significant (P0.05).3 left atrial strain index 3.1 left atrial strain (Strain S): in the left and right ventricular source group, before operation, 1 days after operation, 2 weeks after operation, 4 weeks after operation, there was a statistically significant difference (P0.05), the strain of left atrium increased gradually in each period, and there was no statistical difference between the right ventricular source group and the left ventricular source group before the operation. P0.05, the left atrial strain in the right ventricular source group was higher than that of the left ventricular source group (P0.05).3.2 left atrial strain rate (Strain rate SR) 3.2.1 left ventricular systolic phase (Left ventricular systolic SRs) in the right ventricular source group after operation: the right ventricular source group, 1 days after operation, 2 weeks after the operation, 4 weeks after the operation, there was a significant difference between the 4 weeks after the operation. The increase trend reached the highest value at 4 weeks after the operation, compared with the left ventricular source group, the 1 day after the operation decreased significantly (P0.05), then gradually increased, and then decreased in 2 weeks after the operation, but the difference was not statistically significant (P0.05). The difference was not statistically significant (P0.05) at 4 weeks after the operation, and there was a comparison between the group and the right ventricular source group SRs. There was no statistically significant difference between the groups (P0.05).3.2.2 left ventricular diastolic early diastolic (Left ventricular diastolic early SRe): before operation, 1 days after operation, 2 weeks after operation, there was no statistically significant difference between 4 weeks after operation (P0.05), and there was no difference between the right ventricular source group and the left ventricular source group before operation. Statistical significance (P0.05), after operation, the SRe of right ventricular source group was better than that of left ventricular source group (P0.05).3.2.3 left atrium systolic phase (Left atrial systolic SRa): right ventricular source group, the 1 day after operation was slightly smaller than before operation, the difference was not statistically significant (P0.05); after the operation, 2 weeks after operation, 4 weeks after the operation were significantly higher than before operation (P0.05), 2 weeks after operation and operation after operation. There was no significant difference between the last 4 weeks (P0.05), and there was no significant difference between the left ventricular source group, 1 days after operation, 2 weeks after operation, and 4 weeks after operation (P0.05). The increase of SRa in the right ventricular source group was better than that in the left ventricular source group, but there was no significant difference between the groups (P0.05). Conclusion: 1 the 1 right ventricular sources were in the early radiofrequency ablation. The diameter of left atrium in 2 weeks after operation decreased significantly than that before operation in.2 left ventricular source group. There was no obvious change in the diameter of left atrium within 4 weeks after early radiofrequency ablation. The left atrial ejection function decreased before the early radiofrequency ablation of.3 right ventricular source group. The left atrial ejection function was significantly improved after 4 weeks after ablation, and the strain rate of left atrium was slow from 1 to 4 weeks after operation. The left atrial ejection function decreased before the early frequency ablation of.4 left ventricle. There was no significant improvement in left atrial ejection function within 4 weeks after radiofrequency ablation. Left atrial strain was slowly increased from 1 to 4 weeks after the operation, and the left atrial function in the right ventricular source group was significantly recovered after the operation from 1 to 4 weeks after the operation.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.7

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